Extending Mental Health Support for Aged Care Residents ...



EXTENDING MENTAL HEALTH SUPPORT FOR AGED CARE RESIDENTS DURING COVID-19 Last updated: 23 December 2020From 10 December 2020 to 30 June 2022, the Australian Government has expanded the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (MBS) (Better Access) initiative to aged care residents. Over this period, all eligible aged care residents can access up to 20 Medicare subsidised individual psychological services each calendar year under the Better Access initiative. The expansion recognises the impacts of the COVID-19 pandemic on the mental health and wellbeing of people in residential aged care, and addresses recommendations from the Royal Commission into Aged Care Quality and Safety’s Aged care and COVID-19: a special report. This fact sheet provides information on the expansion for practitioners. What do the changes mean for practitioners?From 10 December 2020 to 30 June 2022, eligible practitioners can deliver individual Better Access services to aged care residents. Services can be delivered face-to-face in aged care facilities, through telehealth (until 31 March 2021) and in practitioners’ consulting rooms. To support practitioners in delivering Better Access services face-to-face in aged care facilities, flag fall items are available for the first resident attended during each attendance at a facility (further detail on page two). Who is eligible?In line with the broader Better Access initiative, support is available to aged care residents with a diagnosed mental disorder who would benefit from a structured, multi-disciplinary approach to the management of their treatment. The conditions classified as mental disorders for the purposes of these services are informed by the World Health Organisation's 1996 Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version. How can aged care residents access Better Access?To access support under Better Access, aged care residents require an approved Mental Health Treatment Plan developed by their General Practitioner (GP) or a Psychiatrist Assessment and Management Plan developed by a psychiatrist. Once a GP has completed a Mental Health Treatment plan they can provide the resident with a referral for mental health services under Better Access.What information should referrals for Better Access services contain? There is no single template for referrals, however referrals should include the aged care resident’s: ? Name ? Date of birth ? Address ? Diagnosis ? List of any current medications ? Number of sessions they are being referred for (the ‘course of treatment’). Where a practitioner receives a referral that does not specify the number of sessions the aged care resident is being referred for, they should contact the referring practitioner to obtain clarification. How many Better Access sessions can a resident be referred for in a single referral?When a GP prepares a Mental Health Treatment Plan for a resident of an aged care facility, they can refer the resident for an initial course of treatment of up to six sessions. The number of sessions in the initial course of treatment must be specified on the referral.Following the completion of the initial course of treatment, the GP must undertake a review. If they consider the resident would benefit from additional sessions, they can provide a referral for up to four more Better Access sessions before conducting another review. Again, the number of sessions the resident is being referred for should be clearly stated on the referral.Once ten sessions have been completed, the reviewing practitioner can provide a referral for up to ten more sessions if they consider this is clinically appropriate, noting a resident can access 20 Better Access sessions in a calendar year. Do practitioners need to claim a ‘review’ item when referring a patient for additional sessions?If a resident of an aged care facility has already had a review of their Mental Health Treatment Plan in the last three months, the practitioner will not be able to claim a ‘review’ item for the patient to access further Better Access sessions. This is due to the claiming restrictions on review items under the MBS. Where a practitioner is referring a resident for a further course of treatment within three months of a review, the practitioner can claim one of the consultation items. Can a referral for Better Access services be used across multiple calendar years?To ensure flexibility, referrals for Better Access services can be used across multiple calendar years, as long as no more than 20 services are accessed in any one calendar year. This is consistent with the existing referral process for Better Access services in the broader community.If a resident of an aged care facility is referred for a specific number of Better Access services and they do not use the full number of services stated on the referral by the end of the calendar year, they can continue to use the referral to access remaining services in the next calendar year. Any services accessed in the following calendar year will count towards the maximum of 20 services in that calendar year. For example, if a resident of an aged care facility is referred for six services in 2021 and only uses four services before 31 December 2021, they can continue to use this referral to access the remaining two services on that referral until 30 June 2022.Once the resident has used all of the services stated on their referral, they will require a new referral to access any additional services up to the maximum of 20 services per calendar year. Which practitioners can deliver psychological services under Better Access? GPs, other medical practitioners, psychologists, social workers and occupational therapists can deliver Better Access psychological services, provided they are registered with Medicare Australia as meeting the eligibility requirements to claim the relevant MBS items. Which MBS items can be used? A table of all new and existing MBS items that can be used by each category of practitioner that can deliver Better Access services is at Appendix A. Are flag fall items available?Flag fall items are available to GPs, other medical practitioners and allied health professionals when delivering individual face-to-face Better Access services in aged care facilities. The flag fall can be claimed for the first resident attended during each attendance at a facility. An overview of each of the flag fall items is below: Practitioner Flag fall item numberBenefit Restrictions GPs 90001 $56.75 Can be claimed only for the first resident attended during each in-person attendance at an aged care facility when claiming items 2733, 2735, 93400, 93401, 93402, 93403, 93421, 93287 or 93288.Other medical practitioners 90002$41.25Can be claimed only for the first resident attended during each in-person attendance at an aged care facility when claiming items 941, 942, 93431, 93432, 93433, 93434, 93451, 93291 or 93292.Allied health professionals 90003$40.00Can be claimed only for the first resident attended during each in-person attendance at an aged care facility when claiming items 93312, 93313, 93316, 93319, 93322, 93323, 93326, 93327, 93375, 93376, 93381 to 93386.Can practitioners deliver services by phone and telehealth? Until 31 March 2021, practitioners can deliver individual Better Access telehealth and phone services to all eligible aged care residents, provided it is safe and clinically appropriate to do so. This aligns with the end date for the COVID-19 temporary MBS telehealth services and use of the items must comply with the rules for these items. No specific equipment is required to provide Medicare-compliant telehealth services. Practitioners must ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws. To assist providers with their privacy obligations, a privacy checklist for telehealth services is available on MBS Online. Further information is on the Australian Cyber Security Centre website. Please note, there is no change to the rules that apply to telehealth items for Modified Monash Model areas?four to seven. Are practitioners required to bulk bill aged care residents?There is no requirement for practitioners to bulk bill aged care residents. It is at the practitioners’ discretion to determine the appropriate billing arrangement, noting aged care residents will only receive the rebate amount attached to the relevant item in the MBS. Are practitioners required to follow COVID-19 safe practices? All services delivered under the expansion are required to align with COVID-19 safe practices. More information on how to stay COVID-19 safe can be found on the Department of Health website.Who was consulted on the changes?The Royal Commission into Aged Care Quality and Safety recommended the immediate creation of MBS items to facilitate access to additional mental health supports for residents of aged care. Consultation was undertaken with relevant stakeholders to inform this measure. How will compliance with the new changes be monitored?The Department of Health will monitor the use by practitioners of new and existing MBS items under the expansion and the number of sessions used by residents of aged care facilities. Use of the items that does not appear to be in accordance with relevant Medicare guidelines and legislation will be actioned appropriately.Where can I find more information?The full item descriptor(s) and information on other changes to the MBS can be found on the MBS?Online website at .au. You can also subscribe to future MBS updates by visiting MBS Online and clicking ‘Subscribe’. The Department of Health provides an email service for providers seeking advice on interpretation of the MBS items and rules, the Health Insurance Act 1973 and associated regulations. If you have a query relating exclusively to interpretation of the Schedule, you should email askMBS@.au.In addition, you can subscribe to ‘News for Health Professionals’ on the Services Australia website to receive regular news highlights.If you are seeking advice in relation to Medicare billing, claiming, payments, or obtaining a provider number, please go to the Health Professionals page on the Services Australia website or contact the Services Australia on the Provider Enquiry Line – 13 21 50. A list of the new and existing items that can be claimed under the expansion is at Appendix A. Please note that the information provided is a general guide only. It is ultimately the responsibility of treating practitioners to use their professional judgment to determine the most clinically appropriate services to provide, and then to ensure that any services billed to Medicare fully meet the eligibility requirements outlined in the legislation. This sheet is current as of the Last updated date shown above, and does not account for MBS changes since that date.Appendix A – MBS item map for Better Access expansion to aged care residents Item numberService CategoryGroupSub GroupMode of service deliveryService LengthRACF specific? Flag fall for first occasion of service during a visit?**GENERAL PRACTITIONERS 93400Preparation of MHTP (Mental Health Skills Training not completed)1A421Face to face20-40 minsYesYes93401Preparation of MHTP (Mental Health Skills Training not completed)1A421Face to face40+ minsYesYes93402Preparation of MHTP (Mental Health Skills Training completed) 1A421Face to face20-40 minsYesYes93403Preparation of MHTP (Mental Health Skills Training completed)1A421Face to face40+ minsYesYes93404Preparation of MHTP (Mental Health Skills Training not completed)1A421Telehealth*20-40 minsYesNo93405Preparation of MHTP (Mental Health Skills Training not completed)1A421Telehealth*40+ minsYesNo93406Preparation of MHTP (Mental Health Skills Training completed)1A421Telehealth*20-40 minsYesNo93407Preparation of MHTP (Mental Health Skills Training completed)1A421Telehealth*40+ minsYesNo93408Preparation of MHTP (Mental Health Skills Training completed)1A421Phone*20-40 minsYesNo93409Preparation of MHTP (Mental Health Skills Training completed)1A421Phone*40+ minsYesNo93410Preparation of MHTP (Mental Health Skills Training completed)1A421Phone*20-40 minsYesNo93411Preparation of MHTP (Mental Health Skills Training completed)1A421Phone*40+ minsYesNo93421Review1A422Face to face?YesYes93422Review1A422Telehealth*?YesNoGENERAL PRACTITIONERS continued93423Review1A422Phone*?YesNo93287Additional FPS Session1A411Face to face30-40 minsYesYes93288Additional FPS Session1A411Face to face40+ minsYesYes2733Initial 10 FPS Session 1A202Face to face30-40 minsYesYes2735Initial 10 FPS Session 1A202Face to face40+ minsYesYes2729Initial FPS Session1A202Telehealth (rural and remote area)30-40 minsNoNo2731Initial FPS Session1A202Telehealth (rural and remote area)40+ minsNoNo91818Initial FPS Session1A403Telehealth*30-40 minsNoNo91819Initial FPS Session1A403Telehealth*40+ minsNoNo91842Initial FPS Session1A4010Phone*30-40 minsNoNo91843Initial FPS Session1A4010Phone*40+ minsNoNo93301Additional FPS Session1A411Telehealth*30-40 minsNoNo93304Additional FPS Session1A411Telehealth*40+ minsNoNo93302Additional FPS Session1A411Phone*30-40 minsNoNoGENERAL PRACTITIONERS continued93305Additional FPS Session1A411Phone*40+ minsNoNoOTHER MEDICAL PRACTITIONERS93431Preparation of MHTP (Mental Health Skills Training not completed)1A423Face to face20-40 minsYesYes93432Preparation of MHTP (Mental Health Skills Training not completed)1A423Face to face40+ minsYesYes93433Preparation of MHTP (Mental Health Skills Training completed)1A423Face to face20-40 minsYesYes93434Preparation of MHTP (Mental Health Skills Training completed)1A423Face to face40+ minsYesYes93435Preparation of MHTP (Mental Health Skills Training not completed)1A423Telehealth*20-40 minsYesNo93436Preparation of MHTP (Mental Health Skills Training not completed)1A423Telehealth*40+ minsYesNo93437Preparation of MHTP (Mental Health Skills Training completed)1A423Telehealth*20-40 minsYesNo93438Preparation of MHTP (Mental Health Skills Training completed)1A423Telehealth*40+ minsYesNo93439Preparation of MHTP (Mental Health Skills Training not completed)1A423Phone*20-40 minsYesNo93440Preparation of MHTP (Mental Health Skills Training not completed)1A423Phone*40+ minsYesNo93441Preparation of MHTP (Mental Health Skills Training completed)1A423Phone*20-40 minsYesNo93442Preparation of MHTP (Mental Health Skills Training completed)1A423Phone*40+ minsYesNo93451Review1A424Face to face?YesYesOTHER MEDICAL PRACTITIONERS continued93452Review1A424Telehealth*?YesNo93453Review1A424Phone*?YesNo93291Additional FPS Sessions1A422Face to face30-40 minsYesYes93292Additional FPS Sessions?1A422Face to face40+ minsYesYes941Initial 10 FPS Session 1A79Face to face30-40 minsYesYes942Initial 10 FPS Session 1A79Face to face40+ minsYesYes371Initial FPS Session1A79Telehealth (rural and remote area)30-40 minsNoNo372Initial FPS Session1A79Telehealth (rural and remote area)40+ minsNoNo91820Initial FPS Session1A403Telehealth*30-40 minsNoNo91821Initial FPS Session1A403Telehealth*40+ minsNoNo91844Initial FPS Session1A4010Phone*30-40 minsNoNo91845Initial FPS Session1A4010Phone*40+ minsNoNo93307Additional FPS Session1A412Telehealth*30-40 minsNoNo93310Additional FPS Session1A412Telehealth*40+ minsNoNoOTHER MEDICAL PRACTITIONERS continued93308Additional FPS Session1A412Phone*30-40 minsNoNo93311Additional FPS Session1A412Phone*40+ minsNoNoCLINICAL PSYCHOLOGISTS93375Initial Psychological Therapy Session1M27N/AFace to Face30-50 minsYesYes93376Initial Psychological Therapy Session1M27N/AFace to Face50+ minsYesYes80001Initial Psychological Therapy Session8M6N/ATelehealth (rural and remote area)30-50 minsNoNo80011Initial Psychological Therapy Session8M6N/ATelehealth (rural and remote area)50+ minsNoNo91166Initial Psychological Therapy Session8M181Telehealth*30-50 minsNoNo91167Initial Psychological Therapy Session8M181Telehealth*50+ minsNoNo91181Initial Psychological Therapy Session8M186Phone*30-50 minsNoNo91182Initial Psychological Therapy Session8M186Phone*50+ minsNoNo93312Additional Psychological Therapy Session1M25N/AFace to Face30-50 minsYesYes93313Additional Psychological Therapy Session1M25N/AFace to Face50+ minsYesYes93331Additional Psychological Therapy Session8M25N/ATelehealth*30-50 minsNoNoCLINICAL PSYCHOLOGISTS continued93334Additional Psychological Therapy Session8M25N/ATelehealth*50+ minsNoNo93332Additional Psychological Therapy Session8M25N/APhone*30-50 minsNoNo93335Additional Psychological Therapy Session8M25N/APhone*50+ minsNoNoREGISTERED PSYCHOLOGISTS93381Initial FPS Session1M28N/AFace to Face20-50 minsYesYes93382Initial FPS Session1M28N/AFace to Face50+ minsYesYes80101Initial FPS Session8M7N/ATelehealth (rural and remote area)20-50 minsNoNo80111Initial FPS Session8M7N/ATelehealth (rural and remote area)50+ minsNoNo91169Initial FPS Session8M182Telehealth*20-50 minsNoNo91170Initial FPS Session8M182Telehealth*50+ minsNoNo91183Initial FPS Session8M187Phone*20-50 minsNoNo91184Initial FPS Session8M187Phone*50+ minsNoNo93316Additional FPS Session1M261Face to Face20-50 minsYesYes93319Additional FPS Session1M262Face to Face50+ minsYesYesREGISTERED PSYCHOLOGISTS continued93351Additional FPS Session8M261Telehealth*20-50 minsNoNo93354Additional FPS Session8M261Telehealth*50+ minsNoNo93352Additional FPS Session8M262Phone*20-50 minsNoNo93355Additional FPS Session8M262Phone*50+ minsNoNoOCCUPATIONAL THERAPISTS93383Initial FPS Session1M28N/AFace to Face20-50 minsYesYes93384Initial FPS Session1M28N/AFace to Face50+ minsYesYes80126Initial FPS Session8M7N/ATelehealth (rural and remote area)20-50 minsNoNo80136Initial FPS Session8M7N/ATelehealth (rural and remote area)50+ minsNoNo91172Initial FPS Session8M183Telehealth*20-50 minsNoNo91173Initial FPS Session8M183Telehealth*50+ minsNoNo91185Initial FPS Session8M188Phone*20-50 minsNoNo91186Initial FPS Session8M188Phone*50+ minsNoNo93322Additional FPS Session1M263Face to Face20-50 minsYesYesOCCUPATIONAL THERAPISTS continued93323Additional FPS Session1M263Face to Face50+ minsYesYes93357Additional FPS Session8M263Telehealth*20-50 minsNoNo93360Additional FPS Session8M263Telehealth*50+ minsNoNo93358Additional FPS Session8M263Phone*20-50 minsNoNo93361Additional FPS Session8M263Phone*50+ minsNoNoSOCIAL WORKERS93385Initial FPS Session1M28N/AFace to Face20-50 minsYesYes93386Initial FPS Session1M28N/AFace to Face50+ minsYesYes80151Initial FPS Session8M7N/ATelehealth (rural and remote area)20-50 minsNoNo80161Initial FPS Session8M7N/ATelehealth (rural and remote area)50+ minsNoNo91175Initial FPS Session8M184Telehealth*20-50 minsNoNo91176Initial FPS Session8M184Telehealth*50+ minsNoNo91187Initial FPS Session8M189Phone*20-50 minsNoNo91188Initial FPS Session8M189Phone*50+ minsNoNoSOCIAL WORKERS continued93326Additional FPS Session1M264Face to Face20-50 minsYesYes93327Additional FPS Session1M264Face to Face50+ minsYesYes93363Additional FPS Session8M264Telehealth*20-50 minsNoNo93366Additional FPS Session8M264Telehealth*50+ minsNoNo93364Additional FPS Session8M264Phone*20-50 minsNoNo93367Additional FPS Session8M264Phone*50+ minsNoNo*Only available for all aged care residents until 31 March 2021**Where more than one resident is seen on a single visit to an aged care facility, the flag fall is only available for the first resident seen. ................
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